Frequently Asked Questions

The Gerber® Start Healthy, Stay Healthy™ Nutrition System

What is the Gerber® Start Healthy, Stay Healthy™ Nutrition System

The Gerber® Start Healthy, Stay Healthy™ Nutrition System is a stage-based nutrition system of products, education and easy to use tools and resources. It is designed to help guide healthy growth and development from pregnancy to preschool and promotes the early establishment of healthy eating habits. The Gerber® Start Healthy, Stay Healthy™ Nutrition System reflects the most up to date nutrition science available. The system uses color-coded Milestone Symbols™ – Birth, Supported Sitter, Sitter, Crawler, Toddler, and Preschooler – to help make understanding childhood nutrition and food choices simpler for parents.

What are Milestone Symbols™, and what age ranges do they represent?

Milestone Symbols™ are color-coded developmental stage-based icons that help identify which Gerber
® products may be right for a child at each stage – based on readiness cues. The Milestone Symbols™ are used on our product packaging and throughout our communications to indicate the starting point for product/information appropriateness. The developmental stages and readiness cues have been validated by feeding and safety experts.

The Milestone Symbols™ designate Gerber
® products which are appropriate for a child, based on particular developmental characteristics, including oral, fine and gross motor development as well as cognitive development. For example, developmental cues indicating that a child may have reached the Sitter stage include: sits independently, picks up and holds small objects in hands, reaches for food or spoon when hungry, and uses upper lip to help clear food off of spoon.

The following highlights show an example of selected oral motor development capability for each milestone and the approximate chronological age:

How do the Gerber food products in the Gerber® Start Healthy, Stay Healthy™ Nutrition System help meet nutritional and developmental needs in the critical early years from birth to 48 months?

The first step in establishing the Gerber® Start Healthy, Stay Healthy™ Nutrition System has been to understand the nutrient needs and current dietary gaps in nutrition during infancy and early childhood, and to compare these to desired food group and nutrient intake recommendations and eating behaviors. The knowledge gained from understanding the nutrient needs and gaps has been used to develop our product and portfolio criteria for use in the nutrition design of current and upcoming products, and ensures our information and education are accurate and science-based.

Gerber products include foods and beverages from most food groups; feature nutrient profiles to help fill common nutrient gaps; and include textures and tastes that are stage-appropriate to help with development of feeding skills. All Gerber products, starting at birth with infant formulas*, and progressing to cereals, baby food, toddler and preschooler foods, are identified by Milestone Symbols™. The
Tools & Guides section of this website features the Gerber® Start Healthy, Stay Healthy™ Menu Planner along with sample menus to demonstrate how we can help parents to plan a healthy diet.

Introduction of complementary/solid foods

What is the definition of 'complementary foods'?

Complementary feeding is defined by the American Academy of Pediatrics as "providing nutrient-containing foods or liquids along with human milk, and includes both solid foods and infant formula." The initiation of foods into the diet is sometimes referred to as the "transitional nutrition phase" to indicate the start of new dietary additions.

What is the recommended age at which to introduce complementary/solid foods?

The American Academy of Pediatrics (AAP) recommends introducing complementary foods between approximately 4 and 6 months of age, based on developmental readiness including oral motor coordination, head control, and the nutritional needs of the infant. Throughout the first year, breastmilk and/or iron-fortified infant formula should remain the infant's primary source of nutrition.

Why should one solid food be introduced at a time to an infant's diet?

The American Academy of Pediatrics (AAP) recommends that one "single ingredient" new food should be introduced at a time so that sufficient time is permitted to observe for possible allergic reactions. New foods are recommended to be introduced only after 3–5 days have transpired. Infant rice cereal is one of the foods least likely to cause allergic reaction. However, it is important to consider key nutrients needed by the infant as well as energy needs when choosing first foods: "the AAP recommends iron-fortified infant cereals and pureed meats as good first foods, because they contain ample protein, iron and zinc."

Recommendations on the order in which complementary/solid foods should be introduced seem to vary. What are the current recommendations?

The American Academy of Pediatrics' (AAP) Pediatric Nutrition Handbook (6th Edition, 2009) states that although no comprehensive research has been conducted on the order in which complementary foods should be introduced, iron-fortified infant cereals are recommended as good first foods based on the protein, iron and zinc content.

The AAP further recommends that pureed meats can be introduced as an early solid food, again providing a source of protein, iron and zinc. The texture of pureed meats would be comparable to food that has been ground or crushed into a thick liquid.

Single grain infant cereals, starting with rice cereal, are generally recommended as the first complementary food. Parents may wish to introduce fruits and vegetables next, but it is important to let them know that there is nutritional value in introducing pureed meats early on, and that the order of introduction of food groups after cereal is not "set in stone". Overall, the AAP recommends that a variety of foods be introduced by the end of the first year, not only to provide required nutrients for growth and development, but also to start developing the infant and young child's appreciation for a diversity of foods, tastes and textures.

Whether meat, fruit, vegetable or mixed dinner (e.g., Gerber
® 2nd Foods
® Purees and 3rd Foods
® Purees, which are combinations of fruits, vegetables, grains, pastas and meats), a puree is defined as finely ground or finely processed food, most often cooked. Pureed food is a term often used to describe baby food.

When a food is pureed, it is turned from a solid form to the consistency of a thick liquid or soft paste. The thickness of a puree will vary depending on the moisture content of the food, and whether liquid has been added. Purees are appropriate first foods for infants because they can be provided in a thin enough consistency that the infant can handle it orally, moving it around with her tongue in order to swallow it.

Parents may choose to prepare pureed foods at home for their child, such as fruits, vegetables and meats, or they may wish to purchase commercially prepared purees. As a note of caution, the American Academy of Pediatrics (AAP) advises that parents need to ensure that nutrient and energy content of home prepared purees is sufficient for their child's needs. A European study found that many home-prepared foods were low in energy, fat, protein, iron and zinc, and that nutrient content was more variable than for infants fed commercial baby foods.

When infants start eating solid foods, parents may become concerned about the change in their child's stool color and consistency. Stools will become more solid and variable in color (for example, stool may be orange in color after the child has eaten carrots). Also, due to the naturally occurring sugars and fats, they will have a much stronger odor as well. Some foods may pass through the GI tract undigested, altering stool appearance. Reassure parents that changes in stool are normal.

American Academy of Pediatrics. Starting Solid Foods: Guidelines for Parents. Adapted from Caring for Your Baby and Young Child: Birth to Age 5, 1997, p. 2.

Cereals

How should infant cereals be mixed with breastmilk or formula when introduced to an infant?

Breastmilk or formula is recommended as the main source of an infant’s nutrition for the first year. When introducing cereals, start with 1–3 tablespoons per day mixed with breastmilk or infant formula to a thin consistency, increasing to 3–4 tablespoons of a thicker consistency twice daily for older infants. Once single grain cereals (rice, barley, oatmeal) have been tried and tolerated well, mixed grain cereals and grain and fruit cereals can be introduced for a variety of tastes and textures.

How can you ensure an infant is getting enough iron?

A healthy, full-term baby builds up adequate iron reserves during the last few months of pregnancy. These stores begin to diminish around 4 months of age. The American Academy of Pediatrics (AAP) recommends that at approximately 4 months of age, breastfed infants should receive an oral iron supplement of 1 mg/kg per day until iron-containing complementary foods are introduced. For formula-fed infants, the AAP states that iron-fortified standard infant formula will provide adequate iron to about age 6 months.

Infants ages 6–12 months need 11 mg of iron per day. When infants are given solid foods, red meat and iron-fortified infant cereals should be introduced. If iron needs are not met by formula and solid foods, liquid iron supplements can be used. Babies born preterm or who are underweight or malnourished need special attention and may require an iron supplement.

Baker RD, Greer FR and the American Academy of Pediatrics Committee on Nutrition. Clinical Report – Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics 2010;126(5):1040–50.

Why choose an infant cereal with probiotics?

Probiotics can help support a healthy digestive tract and some can support development of the immune system. The GI tract is colonized by a complex ecosystem of microbiota (also known as microflora). The bacteria in the GI tract are critical in the development and maturation of the immune response and gut barrier function. At about the same time that an infant is transitioning to solid foods, the protective maternal antibodies transferred to him at birth are declining. His immune system is still developing. Insufficient microbiota can leave a child vulnerable – especially if his mother can't or chooses not to breastfeed.

For infants who are ready for solid foods, GERBER
® DHA & Probiotic cereals have Bifidobacterium lactis (
B. lactis). As the immune system continues to develop, it is important to help support it at every stage. Probiotic bifidobacteria have been shown to benefit the host by promoting a balanced intestinal microbiota to support a healthy immune response.

Vegetables

How and when do you introduce vegetables into an infant's diet?

Vegetable purees can be introduced anytime the infant is developmentally ready for solid foods, after 4 months of age. Cereal is usually introduced first, but once that is accepted, other pureed foods can be provided, including vegetables, meats and fruits. The order of introduction does not matter – but rather a variety of flavors in the diet has been shown to enhance acceptance. At this early age, fruit and vegetable puree consumption is focused more on exploration of flavors and textures rather than on the nutrients provided. The main source of nutrition is still breastmilk or formula and iron-fortified cereals or meats.

The American Academy of Pediatrics (AAP) recommends, as with all foods, that vegetables should be introduced as single ingredients in a pureed form that is appropriate for the infant’s feeding abilities. Introduce foods one at a time with 3 to 5 days between new tastes. Often it may take 8 to15 attempts before a new food is accepted.

Given that FITS found that 30% of toddlers 12–24 months of age don’t eat a single discrete serving of vegetables on a given day, it is critical to encourage the love of vegetables.

Gerber vegetable purees are manufactured using a high temperature/short duration process designed to help preserve natural flavors. They offer variety despite the season, and have no added starch, salt or sugar and no preservatives.

Gerber vegetable purees are made with natural vegetables pureed into developmentally appropriate textures. The texture of the vegetables progresses along with the infant’s feeding skills and developmental stage.

What is the recommended daily amount for vegetables in the first year?

For infants 4–6 months of age (Supported Sitter Milestone) and infants 6+–8+ months of age (Sitter Milestone), about 1/4 cup (4 tablespoons) of pureed vegetables per day is recommended. For infants 8+/10+ months of age (Crawler Milestone), about 1/2 cup (8 tablespoons) of pureed or mashed soft cooked vegetables per day is recommended. Infants who are new to solids may not be ready to consume the recommended amounts, and it is important that their hunger and fullness cues are observed.

Fruits

How do Gerber fruits compare to fresh natural fruits?

Gerber fruits are prepared by processing recently harvested fruits at high temperatures for a very short period, which helps to preserve natural flavors. Year-round availability of fruit purees enables a child to explore new tastes and textures no matter what the season. Fresh fruits are excellent options as well, but it is important that they are carefully prepared to ensure they are developmentally appropriate in texture. Also, fresh fruit choices may be limited by season, and nutrient density may be reduced by extended or improper storage. Encouraging children to choose fruits over less nutritious options begins early. FITS 2008 found that at least 25% of toddlers 12–24 months of age don’t have a single discrete serving of fruit on a given day.

Gerber fruit purees are made with natural fruits and pureed into developmentally appropriate textures. The texture of the fruits progresses along with the infant’s feeding skills and developmental stage.

What is the Recommended Daily Amount for fruits in the first year?

For infants about 4–6 months of age (Supported Sitter Milestone) and infants about 6+–8+ months of age (Sitter Milestone), about 1/4 cup (4 tablespoons) of pureed fruits per day is recommended. For infants about 8+/10+ months of age (Crawler Milestone), about 1/2 cup (8 tablespoons) of pureed or mashed soft fruits per day are recommended. Infants who are new to solids may not be ready to consume the recommended amounts, and it is important that their hunger and fullness cues are observed.

Meats

How and when should meats be introduced into an infant's diet?

The American Academy of Pediatrics’ (AAP) Pediatric Nutrition Handbook (6th Edition, 2009) recommends iron-fortified infant cereals and pureed meats as appropriate first solid foods based on the protein, iron and zinc content. The Feeding Infants and Toddlers Study (2008) found that a subset of infants aged 6–11 months had inadequate intake of iron (12%) and zinc (6%). In keeping with the AAP’s recommendation, pureed meats can be started early in the infant’s introduction to solid foods. Parents should be prepared to provide their infant 8 to 15 opportunities to try pureed meats as a gradual way to support acceptance of these new tastes.

Meat alternatives include eggs, well-cooked and mashed legumes such as beans, lentils and chickpeas, tofu and fish. These protein containing foods are typically introduced at the Crawler stage when the infant is approximately 8+ months of age and is beginning to track and sort pieces of food in the mouth and beginning to use his jaw to mash and chew food. It is important that these foods are cooked thoroughly and mashed to a soft, manageable texture.

Juices

What are the recommendations on how much juice an infant should drink?

Breastmilk or formula should be the infant’s primary source of nutrition and fluids during the first year of life. Infants do not require juice in their diet and the American Academy of Pediatrics (AAP) recommends that infants under 6 months of age should not be offered juice at any time; when juice is introduced, it should be 100% fruit juice. For parents who choose to introduce juice to infants over 6 months of age, start with 1 to 2 fluid ounces of 100% fruit juice a day. Older infants can drink up to 4 fluid ounces (1/2 cup) a day, which is equivalent to one serving of fruit. Juice should preferably be consumed with a meal or snack. The AAP also recommends that parents only feed juice from a cup and not a bottle.

A taste for juice and sweetened beverages often reduces a child’s interest in more nutritious beverages, including milk. Too much juice may contribute to the development of dental caries, may cause diarrhea, and may contribute to excessive weight gain. One tactic for parents to try is to water down juice; however the total quantity of juice consumed per day should still not exceed the recommendations. Only 100% fruit juice should be offered when fruit juice is selected. Gerber juices have added vitamin C, which in addition to its antioxidant properties, also helps the body absorb iron when consumed with iron-rich foods. GERBER
® Harvest Juice has added vitamin E as well. A nice alternative, GERBER
® Yogurt Juice, provides a good source of calcium, vitamin C and 11% of a child’s daily protein per bottle.

American Academy of Pediatrics Committee on Nutrition. The Use and Misuse of Fruit Juice in Pediatrics. Pediatrics 2001;107(5):1210-3. A statement of reaffirmation for this policy was published in Pediatrics 2007;119:405.

Are there any restrictions on the amount of juice a young child should consume in a day?

For children 1 to 6 years old, the American Academy of Pediatrics (AAP) recommends limiting intake of 100% fruit juice to 4–6 fluid oz per day. Fruit "drinks", "beverages" or "cocktails" are not recommended, as these have less than 100% juice, and some have as low as 10% juice. Other specific recommendations from the AAP are as follows:

Juice should not be considered an 'equal' alternative to whole fruit.

Children should be encouraged to eat whole fruits to meet their fruit intake needs.

Children should not consume unpasteurized juice.

Fruit juice has been customarily regarded as a healthy beverage choice for children that supports hydration and may contribute to vitamin C, vitamin A or potassium intake. According to the AAP, by the age of 12 months, 90% of infants are consuming fruit juice. In 2001, the AAP published a policy statement, The Use and Misuse of Fruit Juice in Pediatrics, which discusses excessive juice consumption as a contributing factor to childhood obesity, the development of dental caries, diarrhea, and other gastrointestinal problems, such as excessive gas, bloating and abdominal pain.

American Academy of Pediatrics Committee on Nutrition. The Use and Misuse of Fruit Juice in Pediatrics. Pediatrics 2001;107(5):1210-3. A statement of reaffirmation for this policy was published in Pediatrics 2007;119:405.

Dairy

How important is dairy in the diet of toddlers and preschoolers?

The American Academy of Pediatrics (AAP) states that the unique combination of bone-building nutrients like calcium, vitamin D and protein in milk and dairy products is "essential for growth in children". U.S. dietary guidelines recommend 2 servings a day for children <4 years, increasing to 3 servings per day for children between 4 and 8 years. For toddlers and preschoolers, the recommended daily amount for dairy products is 2 cups per day.

GERBER
® GRADUATES
® Smart Sips™ is a dairy beverage with the benefit of added vitamins and minerals including vitamins E & D, iron, and calcium, and offers another option for including dairy products in the daily diet. Another option for adding dairy to the diet is GERBER
® GRADUATES
® Yogurt Melts
®, made with 99% real yogurt and fruit that contain live and active cultures.

Lactose-intolerant children may consume dairy each day by selecting fermented dairy products with live cultures such as plain yogurt, kefir, buttermilk, or GERBER
® Yogurt Blends Snack, based on individual tolerance. Trial and experimentation is encouraged.

Snacks

Can snacks play a role in a child's healthy diet?

Snacks make up an important part of a child’s diet. Young children have relatively high nutrient needs for the small amount of calories they need. Three meals and 2–3 healthy snacks/day can help children meet these daily nutrition requirements. For a child, snacktime should be considered a small meal, so it is important to make sure that the foods offered are nutritious. To make the most of snacktime, parents and caregivers should offer a variety of healthy choices – containing a good source of nutrients – and be consistent with the time snacks are served. In terms of development, snacks offer opportunities for older infants to develop their self-feeding skills.

According to the 2002 Feeding Infants and Toddlers Study (FITS), 25% of a toddler's calories come from foods eaten at snack time. Based on the expanded FITS 2008 data, recommendations focus on the toddler and preschool period as a critical time to help parents instill healthful, long-term dietary and activity behaviors in their children and family. Two suggestions specifically impact snack choices:

Offer fruits and vegetables at meals and snacks

Limit the frequency of fast food dining since choices can be high in calories, fat, sugar, and salt.

Feeding Infants and Toddlers Study (FITS) 2008. JADA 2010;110(12):Suppl 3. Food Consumption Patterns of Young Preschoolers: Are They Starting Off on the Right Path? p. S58.

Why is there no fiber indicated on GERBER® GRADUATES® Puffs product label?

The Nutrition Facts provided on the label are based on a 1/2 cup (7 g) serving. Fiber content is lower than a full gram for this serving size, so is declared on the label as 0 g. GERBER
® GRADUATES
® Puffs are made with whole grains. Whole grain foods have unique tastes and textures – which are important in the development of the infant’s appreciation of different tastes as well as healthy eating habits.

The American Academy of Pediatrics (AAP) recommends that between 6 and 12 months of age, whole cereals, green vegetables and legumes be introduced to gradually increase the amount of fiber in the diet to 5 g/day by the age of 12 months. The daily recommended intake for children 1–3 years is 19 g/day, and for children 4–8 years is 25 g/day.

Water

How much water should infants and children consume?

According to the American Dietetic Association, breastfed and formula-fed infants usually do not need additional water. It has been estimated that infants need 1.5 mL water/kcal of energy expenditure for adequate intakes; this water-to-energy ratio corresponds to that found in breastmilk and routine infant formulas. Caution also must be used so that water does not displace needed energy and nutrients in the diet. In unusually hot weather, infants may need some additional water. Introducing infants to sips of water also may help them learn to drink water to quench thirst.

Water is the best way to keep toddlers and older children hydrated. During hot months when children lose more fluids, parents can offer water 2 or more times a day. Of particular importance is maintaining proper hydration during illness. Vomiting and diarrhea can lead to dehydration if not balanced by adequate fluid and electrolyte intake.

The Institute of Medicine recommends that Adequate Intake for water for infants 0–6 months is 0.7 liters/day, and for infants 7–12 months is 0.8 liters/day.

GERBER
® Pure™ Water is a purified water according to FDA regulations. Minerals are added to enhance taste and do not provide any nutritional value. It does not contain added fluoride. While GERBER
® Pure™ Water is a purified water, it is not sterile. It should be refrigerated after opening and used within seven days. Good sanitation practices should be used to maintain product purity. GERBER
® Pure™ Water undergoes an extensive multi-step process to ensure consistent purity and quality. Our processes are among the most advanced for purifying and treating water. GERBER
® Pure™ Water is not just tap water in a bottle. GERBER
® Pure™ Water offers a fluoride-free choice for parents and healthcare professionals. Gerber recommends that parents discuss with their doctor all the possible sources of fluoride in their baby’s diet including dietary supplements. GERBER
® Pure™ Water is not a nutrient or electrolyte replacement, but rather is designed for mixing with formula and cereal.

General

How can I obtain an answer for a question not listed in the medical.gerber.com FAQs?

If you don't see your question here, then please contact us at the
Gerber® Start Healthy, Stay Healthy™ Resource Center at 1-800-628-BABY (2229) for questions and support including menu planner consultations with a registered dietitian. Our nutrition experts are on call to assist you from Monday to Friday, 8:00 AM to 8:00 PM Eastern Time.

How can I find out more about special diets for pediatric patients, or learn about the nutrient content or kosher status of Gerber products?

Please contact us at the
Gerber® Start Healthy, Stay Healthy™ Resource Center at 1-800-628-BABY (2229) for questions and support. Our nutrition experts are on call to assist you from Monday to Friday, 8:00 AM to 8:00 PM Eastern Time.

The content on this site is for educational purposes only and is intended solely for medical professionals in the United States only. If you are not a medical professional, please visit www.gerber.com.

All trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland or used with permission.